Provider Demographics
NPI:1396098190
Name:HERITAGE YOUTH SERVICERS
Entity type:Organization
Organization Name:HERITAGE YOUTH SERVICERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-873-3270
Mailing Address - Street 1:31 E 1600 N
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1011
Mailing Address - Country:US
Mailing Address - Phone:801-798-9077
Mailing Address - Fax:
Practice Address - Street 1:19675 S. HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:BIRDSEYE
Practice Address - State:UT
Practice Address - Zip Code:84629
Practice Address - Country:US
Practice Address - Phone:801-873-3270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness